Daphne Boot

Relation of out of hours activity by general practice and accident and emergency services with deprivation in Nottingham: longitudinal survey.

Abstract Objectives: To investigate the relation between out of hours activity of general practice and accident and emergency services with deprivation and distance from accident and emergency department. Design: Six month longitudinal study. Setting: Six general practices and the sole accident and emergency department in Nottingham. Subjects: 4745 out of hours contacts generated by 45 182 patients from 23 electoral wards registered with six practices. Main outcome measures: Rates of out of hours contacts for general practice and accident and emergency services calculated by electoral ward; Jarman and Townsend deprivation scores and distance from accident and emergency department of electoral wards. Results: Distances of wards from accident and emergency department ranged from 0.8 to 9 km, and Jarman deprivation scores ranged from −23.4 to 51.8. Out of hours contacts varied by ward from 110 to 350 events/1000 patients/year, and 58% of this variation was explained by the Jarman score. General practice and accident and emergency rates were positively correlated (Pearson coefficient 0.50, P=0.015). Proximity to accident and emergency department was not significantly associated with increased activity when deprivation was included in regression analysis. One practice had substantially higher out of hours activity (B coefficient 124 (95% confidence interval 67 to 181)) even when deprivation was included in regression analysis. Conclusions: A disproportionate amount of out of hours workload fell on deprived inner city practices. High general practice and high accident and emergency activity occurred in the same areas rather than one service substituting for the other. Key messages We studied the out of hours activity of six general practices and the local accident and emergency department in Nottingham for six months There were wide variations between electoral wards in both general practice and accident and emergency events Deprivation scores explained more than half of the variation, with out of hours activity being highest in deprived inner city areas Highly deprived areas close to the accident and emergency department generated high levels of work for both general practice and accident and emergency services, with no evidence of one service substituting for the other

Ethnic factors in voluntary and compulsory admissions.

Socio-demographic and clinical aspects of compulsory and informal admissions to general adult psychiatry wards over a two-year period are compared. In addition, Afro-Caribbean patients are compared with white UK-born patients. Relative rates of admission are examined. The study confirms other reports of greater than expected compulsory admissions of Afro-Caribbean patients and pays particular attention to the circumstances preceding compulsory entry to hospital and the persons and agencies involved in that process.

Age and proximity to death as predictors of GP care costs: results from a study of nursing home patients

This paper reports the results of a study of GP costs associated with a group of nursing home patients who died at various stages during a 12-month period. The relationship between costs per month of care, patient age and proximity to death, where sex and diagnosis are controlled for are reported. A comparison of care costs for patients in their last year of life and those who survived the course of the study is also made. The study found that those in their last year of life were significantly more expensive to care for than those who survived the duration of the study, but that there was no statistically significant difference in age. In multivariate regression analyses, it was also found that among those who died during the study care costs were unrelated to age, but significantly related to proximity to death. The study supports the contention of others (Zweifel P, Felder S, Meiers M. Ageing of population and health care expenditure: a red herring? Health Econ 1999; 8: 485-496) that health care costs are more directly related to proximity to death than age.

Evaluation of the short-term impact of counseling in general practice

This paper describes the findings of a randomised controlled trial of the short-term impact of counseling in the general practice setting. Compared with patients who received usual advice from their general practitioner for acute problems such as relationship difficulties, anxiety and depression, those who received counseling from qualified counselors working within the primary health care context showed greater improvement in psychological health as measured by the General Health Questionnaire. Significantly fewer of those counselled were prescribed anti-depressant drugs by the general practitioners in the study, or were referred to psychiatrists or clinical psychologists for care. In addition those patients who attended sessions with the practice counselor were more likely to report that they were satisfied with their treatment and more expressed feelings of well-being.

The impact of nursing home patients on prescribing costs in general practice.

Objectives: To compare the costs of prescribing for older people in nursing homes with older people living at home and to compare patterns of prescribing between these two groups.

Explaining variations in prescribing costs: results from a comparison of nursing home patients with matched pairs living in the community.

Objectives: To examine and explain variations in prescribing costs associated with nursing home patients and patients matched by age and sex living in the community.

Hemispheric Asymmetries in Developmental Dyslexia: Cerebral Structure or Attentional Strategies?

Two experiments investigated visual processing asymmetries in normal and dyslexic readers, with unilateral tachistoscopic presentations. The experiments employed randomized or blocked presentations of verbal and nonverbal materials to determine whether previously reported differences between dyslexics and normals were due to structural hemispheric differences or to strategical processing differences. The results indicate that if dyslexics are unable to predict the nature of the stimulus, then they behave as normal readers. Their atypical laterality emerges only when they can adopt a strategy in anticipation of a specific type of stimulus. This leads to the suggestion that developmental dyslexia is associated more with inappropriate modes of thought than it is with hemispheric dysfunction.